Defining Quality Metrics for Telemedicine in Surgery: A Critical Examination
Clinical Snapshot
PICO Framework
| P — Population | Surgical patients receiving telemedicine-based care across preoperative, intraoperative, and postoperative phases in the United States |
| I — Intervention | Structured quality metric framework for surgical telemedicine based on the Donabedian model (structure, process, outcome domains) |
| C — Comparator | Existing AHRQ and WHO quality frameworks; in-person surgical care delivery |
| O — Outcomes | Patient satisfaction, cost-effectiveness, diagnostic accuracy, access equity, and standardised quality indicators for surgical telemedicine |
Bottom Line
This paper from the American College of Surgeons Telehealth Pillar proposes a Donabedian-based quality metric framework for surgical telemedicine, addressing structure, process, and outcome domains across preoperative, intraoperative, and postoperative care phases. It fills an important conceptual gap — the absence of surgery-specific telemedicine quality standards — and offers a pragmatic implementation roadmap. However, the evidence base is limited: no primary data are presented, the consensus methodology is informal, and all proposed metrics require prospective validation. The comparative analysis with AHRQ and WHO frameworks is a useful contribution, but the US-centric design limits direct applicability to Australian surgical practice without adaptation for MBS telehealth items, AHPRA requirements, and RACS guidelines. Senior clinicians and health system leaders should treat this framework as a well-reasoned starting point for local metric development rather than an evidence-based standard. The most immediate clinical utility lies in prompting surgical departments to audit their existing telemedicine quality measurement practices against the proposed domains. Robust Delphi studies, prospective cohort validation, and patient co-design processes are needed before these metrics can be adopted as benchmarks for accreditation or reimbursement purposes.
Key Findings
P Value: Not reported — framework development study
Effect Size: Not applicable — no primary quantitative data reported
Primary Outcome: Proposed structured quality metric framework for surgical telemedicine based on Donabedian domains (structure, process, outcome) across preoperative, intraoperative, and postoperative phases
Nnt Or Sensitivity: Not applicable — no diagnostic test evaluation or therapeutic trial conducted; narrative synthesis suggests telemedicine yields 'equivalent or improved outcomes' compared with in-person visits, but specific effect estimates are not provided in the abstract
Confidence Interval: Not reported — framework development study
Clinical Application
The proposed framework is conceptually feasible for health systems with existing telemedicine infrastructure. However, implementation requires investment in digital platforms, staff training, patient digital literacy support, and governance structures. The authors appropriately stratify metrics into immediate and future implementation tiers, which aids practical adoption. Feasibility in resource-limited or rural settings remains unvalidated. Australia has a well-established telehealth infrastructure, accelerated by MBS telehealth item expansion during the COVID-19 pandemic. The Royal Australasian College of Surgeons (RACS) has published position statements on telehealth in surgical practice. The Donabedian framework proposed is applicable within Australian quality and safety governance (ACSQHC National Safety and Quality Health Service Standards). However, specific metric adaptation is required: MBS telehealth item eligibility criteria differ from US CMS rules; AHPRA registration and cross-jurisdictional practice requirements apply; PBS-listed medications for perioperative care have distinct prescribing pathways via telehealth. The Australian Digital Health Agency's national telehealth strategy and My Health Record integration are relevant structural considerations not addressed in this US-centric paper. RACGP and RACS collaboration would be essential for Australian metric validation. Surgical patients across all phases of care (preoperative assessment, postoperative follow-up, and emerging intraoperative teleconsultation) in settings where telemedicine is deployed, particularly those in geographically remote or underserved areas
Abstract
The rapid adoption of telemedicine has transformed healthcare delivery in the US, enhancing access and communication for surgical patients across wide geographic areas. However, a critical challenge persists: the need to define and standardize quality metrics specifically for telemedicine in surgery. Existing studies suggest that telemedicine can yield equivalent or improved outcomes compared with in-person visits. Nevertheless, literature remains limited in evaluating patient satisfaction, cost-effectiveness, and diagnostic accuracy. Through expert consensus within the American College of Surgeons Board of Governors Telehealth Pillar, we propose a structured framework for defining and implementing quality metrics for surgical telemedicine. This is based on the Donabedian model, addressing structure, process, and outcome, while also considering the distinct phases of surgical care: preoperative, intraoperative, and postoperative. This framework identifies unique domains of telemedicine in surgical care, emphasizing hospital and organizational structure, patient and provider readiness, and policy alignment. A comparative analysis with existing AHRQ and WHO frameworks highlights gaps in surgical applicability. Finally, we propose an implementation roadmap prioritizing immediate, feasible metrics while identifying areas for future validation. Collaboration among researchers, clinicians, and policymakers will be essential to establish these metrics and ensure that telemedicine delivers on its potential to improve surgical care delivery while addressing disparities in access and outcomes.
References
- 1.Shao, C. C., Hashmi, Z. G., Brooke, B. S., Huang, E. Y., Wisbach, G., Sawyer, M. D., Redan, J., Adelson, P. D., Sewell, M., Singh, N., & Woo, R. (2026). Defining quality metrics for telemedicine in surgery: A critical examination. Journal of the American College of Surgeons. Advance online publication. https://doi.org/10.1097/XCS.0000000000001922
Related Research
Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy
Ventral hernia repair in emergency settings. A machine learning model to predict post-operative complications.
3 Aug 2026
Journal of pediatric surgery
Interpretable deep learning model for pediatric strangulated small bowel obstruction on CT: A multicenter study
3 Aug 2026
European journal of radiology
A CT-based deep learning model to differentiate between benign and malignant adrenal lesions
3 Aug 2026
This content is for educational purposes for healthcare professionals only and does not constitute clinical advice. Clinical decisions should be based on individual patient assessment, current guidelines, and appropriate specialist consultation. Editorial Standards · Privacy Policy · Terms of Service